Recently I was asked by a newspaper reporter to give her a few examples of the value of specialty training in balancing female hormones since other doctors prescribe hormones too, even without this training. Here are some practical examples:

Common cases of infertility

First, couples who have undergone all the usual fertility tests and are still unable to produce pregnancy, despite the tests being normal sometimes, find their way to me as a last resort. Miscarriages are sometimes part of their stories. Fertility meds (like Clomid, for example) have been put on the back burner because of concerns about possible multiple eggs being fertilized. In these cases I measure the movement of estrogen and progesterone throughout the entire cycle (one month) and then prescribe the exact amount of progesterone needed to balance the estrogen. Sometimes the estrogen needs to be lowered a little because it is being produced in excess amounts. Even testosterone and a stress hormone, DHEA, are measured throughout the month and then adjusted if necessary. This personalized approach has worked every time except for two cases in which the ovaries were damaged by viruses.

2. Common cases of persistent discomfort, such as hot flashes, despite routine hormone replacement therapy I see many peri-and-postmenopausal women who have been prescribed too much estrogen and too little or no progesterone, and they are still struggling with sleep-disrupting hot flashes and/or nightsweats. There are several reasons for this, most notably the problems with testing and not knowing how much progesterone is required to balance the estrogen.

Blood tests are often not done because they don't provide enough useful information or because the woman's hormones are still moving up and down (peri-menopause), and a single sample tells us too little about this movement. Also, the normal ranges for estrogens and progesterone are too wide to be accurate enough.

Most people don't realize that this source of so much unnecessary suffering, namely estrogen dominance, can occur in many women even when they take no hormones at all. Why? Because estrogens (the strongest being estradiol) can be made very easily and abundantly by fat cells, not just by the ovaries and adrenal glands. This is the reason so many women have the symptoms and signs of excess estrogen. Progesterone, with its opposite effects, can be made only by the ovaries, so when the ovaries are going to sleep, in and around menopause, its level never comes back up. Typically, it gradually falls slowly to the basement.

At this point, let me re-emphasize that when the uterus has been removed and the patient has been given no progesterone, the resulting estrogen dominance can be uncomfortable and unsafe because progesterone is not only for the uterus lining; it also is for the mind and to help lower estrogen's risk of overstimulating growth of unwanted tissue: fat, breast cysts, even estrogen- sensitive cancers.

3. Fine tuning estrogen The Post-Menopause Hormone Panel saliva test, done by the lab that helped train me, tells me precisely how much of this growth over stimulation by estrogen is happening in the woman's body. We call this the "proliferative potential." This is why I prefer to prescribe a form of estrogen that can be adjusted up or down in tiny increments. This is NOT a skin cream. It is a liquid in which even just one drop, more or less, can make all the difference in both comfort and safety.

Finally, there is an overwhelming need for personalized, precise hormone therapy, and many desperate women are turning to practitioners without specialized training. As I mentioned above, the result is that these women come to me as a last resort. This is just another unfortunate side of a desperate, unresolved situation.